Healthcare Provider Details

I. General information

NPI: 1144142597
Provider Name (Legal Business Name): MRS. AMY NICOLE GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7765 LAKE WORTH RD # 1047
LAKE WORTH FL
33467-2536
US

IV. Provider business mailing address

386 W 15TH ST
RIVIERA BEACH FL
33404-6108
US

V. Phone/Fax

Practice location:
  • Phone: 561-294-4889
  • Fax:
Mailing address:
  • Phone: 561-294-4889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberDOU-PBC-3608513
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: